远端半针Ilizarov外固定器结合微创截骨术治疗膝内翻畸形  

The modified Iiizarov device combined with minimally invasive osteotomy in the treatment of genu varum deformity

作　　者：秦泗河 郑学建[1] 夏和桃 韩义连 任龙喜[1] 

机构地区：[1]北京市垂杨柳医院矫形外科,100022 [2]北京丰台广济医院骨科

出　　处：《中华骨科杂志》2012年第3期199-204,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨远端半针Ilizarov外固定器结合微创截骨术矫治膝内翻畸形的临床疗效。方法回顾性分析2002年2月至2010年5月收治的31例膝内翻畸形患者的病例，男8例，女23例；年龄18—69岁，平均35．6岁；单侧6例，双侧25例，共56膝。术前膝内翻角度为7．7°-38．2°，平均17．0°±8．8°。根据美国膝关节关节协会评分（kneesocietyscore，KSS）为34±100分，平均（86．2±18．5）分。确定成角旋转中心与截骨矫形的位置，在胫骨畸形交点处用微创截骨器截骨，腓骨在头下截骨。安装术前已组装好的Ilizarov外固定器，通过调整伸缩内、外侧支架螺杆的长度渐进矫正内翻畸形。采用X线检查及膝关节KSS临床评分，结合行走时自我感觉及有无并发症等4项内容综合评价临床疗效。结果患者佩戴Ilizarov外固定器的时间为9-20周，平均12周；随访时间14-50．4个月，平均30．5个月。末次随访时膝内翻角度为-3°-2．4°，平均1．7°±0．9°；膝关节KSS评分为75-100分，平均（96．1±7．7）分，其中优49例，良6例，可1例，优良率为98．2％（55／56）。11例患者术后早期发生轻度针道感染，经常规换药后感染控制；3例术后发生针道松动，经更换针道后恢复固定强度。结论远端半针Ilizarov外固定器结合微创截骨术矫治膝内翻畸形具有微创、安全、动态矫形及符合美学要求的特点，临床效果满意。Objective To evaluate the effect of modified Ilizarov device combined with minimally invasive osteotomy in the treatment of genu varum deformity. Methods From February 2002 to May 2010, a total of 31 patients with genu varum deformity who had underwent corrections by using modified llizarov device combined with minimally invasive osteotomy were retrospectively analyzed, including 8 males and 23 females with an average age of 35.6 years （range, 18-69 years）. Fifty-six knees were involved in the 31 patients. Preoperatiw angle of genu varum was 17.0°±8.8°. According to the American knee society score （KSS）, preoperative score was about 34-100 point with an average of 86.2±18.5. After determining the cen- ter of rotation angulation, osteotomy was performed in the site of tibial deformity and below the fibular head with minimally invasive device respectively. Prepared modified Ilizarov device was assembled and fixed with kirschner wire. Then genu varum deformity was progressively corrected by adjusting the length of bilateral bolts. X-ray film, KSS score, subjective sensation, and occurrence of complication were used to evaluate the therapeutic effects. Results Modified Ilizarov devices were used in 56 knees for 9-20 weeks, all patients were followed up for 14-50.4 months, with an average of 30.5 months. The angle of genu varum deformity was 1.7°±0.9°, the KSS was 96.1±7.7. According to KSS, the results were excellent in 49 knees, good in 6, fair in 1, with the excellent and good rate was 98.2% （55/56）. The complications included pin site infection in 11 patients and pin loosening in 3 ones; they were healed through routine dressing change and replacing pin site respectively. Conclusion Modified Iilizarov device combined with minimally invasive osteotomy for the treatment of genu varum deformity can achieve a satisfactory therapeutic effect.

关 键 词：伊利扎罗夫技术 外固定器 截骨术 膝关节 畸形 

分 类 号：R687.3[医药卫生—骨科学]